Nearly 25% of Antibiotic Prescriptions Are Unnecessary, Study Finds

While major health organizations including the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) have been sounding the alarm on the dangers of antibiotic resistance for years, it may have had little effect on how often antibiotics are doled out.
Nearly 25 percent of antibiotic prescriptions are unnecessary in the United States, concludes a new study published January 16 in the BMJ.
“We haven’t made a lot of progress,” said Dr. Kao-Ping Chua, PhD, assistant professor of pediatrics at the University of Michigan Medical School and CS Mott Children’s Hospital and first author of the study.
“One out of seven participants in our study received inappropriate antibiotics, and that’s just the antibiotics we could tell were inappropriate based on the associated diagnosis.”
Chua and his team sifted through the data of more than 15 million antibiotic prescriptions from insurance and claims data associated with 19 million privately insured Americans.
Using International Classification of Diseases (ICD) codes (medical billing codes used to describe disease), the authors developed a classification system for when antibiotics should be appropriately prescribed.
They created a three-tier system of “always” (if the associated condition almost always requires antibiotics), “sometimes” (if the condition has a potential indication for antibiotics), and “never” (when the indication almost never calls for antibiotics).
For example, bacterial pneumonia and strep throat (streptococcal pharyngitis) almost always require antibiotics, whereas viral pneumonia and chronic rhinitis rarely do.
The problem seems to come from numerous diagnoses in the “sometimes” category that lead to cases in which prescribing an antibiotic may or may not be the right thing to do.
“Looking at these results, we can only be confident that 13 percent of antibiotic prescriptions are OK,” Chua said. “The other 87 percent might not be inappropriate, but our data suggest that the appropriateness of those prescriptions isn’t very high.”
This study isn’t the first to confirm that overprescribing antibiotics is a major issue in the healthcare system.
A report issued by the CDC in 2016 found that one in three antibiotic prescriptions was unnecessary.
But Chua warns that due to differences in how the two studies were conducted, they can’t be compared identically. He said it shouldn’t be concluded that overprescribing has somehow declined since the CDC report in 2016.
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Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City, said the percent of inappropriate antibiotic prescriptions is likely even higher than Chua’s research indicates.
“The battle of prescribing antibiotics goes on every day in doctors’ offices, hospitals, and emergency rooms,” Horovitz told Healthline.
“Many people come in with what they think requires an antibiotic and they don’t want to settle for less than that,” he said. “They need to be convinced that it’s not appropriate.”
Horovitz is not affiliated with the study.
According to Horovitz, there needs to be a cultural shift in order to move people away from immediately asking for antibiotics, often when they’re not necessary.
Antibiotics are frequently viewed as a “magic bullet,” even in cases of viral infection where an antibiotic will have no effect.
“People end up getting things that they don’t need because they’re coming in for an office visit and want to get something other than reassurance and proper advice,” he said. “They want a pill.”
The WHO calls antibiotic resistance — which is the process through which bacteria become resistant or immune to antibiotics — “one of the biggest threats to global health, food security, and development today.”
Instances of antibiotic resistant superbugs including pneumonia, tuberculosis, gonorrhoea, and salmonellosis have already been documented.
“Antibiotic overuse is widespread and rampant,” Chua said. “Antibiotic overuse is a major driver of antibiotic resistance. It’s up to doctors to stop prescribing antibiotics unnecessarily, for the sake of patients and society in general.”